NPI | 1639129109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 2013027461) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 036-108996) |
Enumeration Date | 2006-05-12 |
Last Update Date | 2022-01-14 |